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PDA Management in the First Month in High-Risk Preterm Neonate Clinical Pathway – N/IICU and Inpatient

N/IICU Clinical Pathway for the Evaluation and Management of Patent Ductus Arteriosus (PDA) in Neonates Born < 29 wks Gestational Age

  • A hemodynamically significant PDA (hsPDA) is a PDA causing both clinical and echocardiographic changes that has significant impact on the physiologic stability of the neonate
  • Avoid preventative or routine treatment of a hsPDA in neonates < 14 days old
  • Evaluation and pharmacologic treatment for neonates between 14–28 days old should be reserved for those with significant clinical symptoms
Summary of Pathway Updates
Adapted from AAP Guidelines 2025 and Recent Studies

Evaluation and Management of PDA in Neonate < 29 wks GA

 
 
  • Exclusions
    • Congenital heart disease
    • Pulmonary hypertension
    • > 28 days of age, Consult Cardiology
 
 
 
 
Mild or Few Moderate Symptoms
Multiple Moderate or > 1 Severe Symptoms
 
 
 
 
  • Conservative Clinical Management
    • Fluid restriction
    • Increasing PEEP
  • Enteral Feedings
Clinical worsening
 
 
 
 
 
 
Small non-hsPDA or moderate hsPDA
Large hsPDA
 
 
 
 
 
 

Discharge

  • Discuss with cardiology
    • Discharge Echocardiogram
    • Follow-Up Plan
Stable
 
 
Clinical worsening
 
 
Clinical worsening
 
 
Clinical worsening
 
 
 
 
  • Discuss with cardiology
    • Discharge Echocardiogram
    • Follow-Up Plan

 

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